Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA52081 | FL |
N | 225700000X | Massage Therapist | MT711 | ME |
NPI | 1003050964 |
---|---|
Provider Name | Ms. Laura K Tehennepe |
First Address | Gainesville, FL 32601-5552 |
Second Address | Gainesville, FL 32601-5552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2009 |
Last Update Date | 08/04/2014 |